Purpose: Understanding the muscular structure of the anal canal is crucial for the diagnosis and treatment of anorectal diseases. Treitz muscle is a vital yet poorly understood component. It supports the anal venous plexus and contributes to anal cushion formation. However, its anatomical details remain unclear, and various theories suggest different origins for its muscle bundles, which affects our understanding of the pathophysiology of hemorrhoids. In this study, we sought to clarify the origin and localization of Treitz muscle to provide an anatomical foundation for understanding anal function. Methods: In this descriptive cadaveric study of 11 cadavers, we performed macroscopic examinations and immunohistological analyses on tissues from the anterior, lateral, and posterior walls of the anal canal. The origin and localization of Treitz muscle were qualitatively evaluated. Results: Treitz muscle is a smooth muscle formed by a directional change in the muscle bundles of the internal anal sphincter, running longitudinally along its surface. A shift in the direction of muscle bundles originating from the internal anal sphincter, giving rise to Treitz muscle, was frequently observed in the anterolateral wall of the anal canal. Conclusion In summary, Treitz muscle, a smooth muscle extending from the internal anal sphincter, is considered part of the muscularis propria. Its directional shift was localized to the anterolateral wall, indicating that Treitz muscle is not uniformly distributed around the anal canal. This site-specific localization may influence the risk of hemorrhoids or cancer invasion depending on its anatomical position.

The transition to the new specialist certification system has progressed in cardiovascular surgery, enabling many surgeons to obtain specialist certification earlier than before. This study focuses on conditions that are particularly easy to overlook factors in the application process, namely academic activities, surgical experience, and Off-the-Job Training (OJT). This report summarizes these changes to facilitate efficient specialist certification applications for trainees.

Anterior talofibular ligament (ATFL) injuries are the most common cause of ankle sprains. To ensure anatomically accurate surgery and ultrasound imaging of the ATFL, anatomical knowledge of the bony landmarks around the ATFL attachment to the distal fibula is required. The purpose of the present study was to anatomically investigate the ATFL attachment to the fibula with respect to bone morphology and attachment structures. First, we analyzed 36 feet using microcomputed tomography. After excluding 9 feet for deformities, the remaining 27 feet were used for chemically debrided bone analysis and macroscopic and histological observations. Ten feet of living specimens were observed using ultrasonography.We found that a bony ridge was present at the boundary between the attachments of the ATFL and calcaneofibular ligament (CFL) to the fibula. These two attachments could be distinguished based on a difference in fiber orientation. Histologically, the ATFL was attached to the anterodistal part of the fibula via fibrocartilage anterior to the bony ridge indicating the border with the CFL attachment. Using ultrasonography in living specimens, the bony ridge and hyperechoic fibrillar pattern of the ATFL could be visualized. We established that the bony ridge corresponded to the posterior margin of the ATFL attachment itself. The ridge was obvious, and the superior fibers of the ATFL have directly attached anteriorly to it. This bony ridge could become a valuable and easy-to-use landmark for ultrasound imaging of the ATFL attachment if combined with the identification of the fibrillar pattern of the ATFL.

Introduction: This study aims to examine the actual conditions of Institutional Research (IR) activities and operations and explore the differences between the items analyzed by the IR organization and those that nursing faculty members would like to compare with other Japanese nursing universities.　Method: We conducted a questionnaire survey among 48 nursing universities in Japan (424 instructors) in December 2020.　Results: Of the total 116 participants, the number of participants who responded to being aware of both the name and role of IR and having an IR organization in their universities was 51 (44.0%) and 82 (70.7%), respectively. Teaching-related items ranked high in both the items analyzed by the IR organization and those that nursing faculty members would like to compare with other nursing universities. For the survey of admission applicants and graduates, the degree of the desire to be compared with other nursing universities was higher than that of being analyzed by the IR organization (p<0.05).　Discussion: Although a greater number of IR organizations are being established, awareness of these remains low within Japanese nursing universities. Additionally, there are differences between the items analyzed by the IR organization and those that nursing faculty members would like to compare with other Japanese nursing universities. Therefore, the goal is to achieve a common understanding of IR activities and operations at each nursing university.

The malaris muscle has long been described as one of the facial muscles. Numerous studies have attempted to define and examine the malaris muscle owing to its clinical implications related to the facial aesthetic concept. In the anatomical context, however, the concept of the malaris muscle remains ambiguous. This review article proposes a reconsideration of the malaris muscle. The article focuses on the anatomical concept of the malaris muscle from previous studies to the current studies as well as the conceptual changes in the malaris muscle. To improve understanding of the role of the malaris muscle in the facial aesthetic aspects, here the article reviews the role of the malaris muscle in facial aging appearance and discusses the practical clinical applications surrounding this aging gradation.
Aging ; Facial Muscles

[Objective]More accurate data on the positional relationship between the acupuncture points belonging to the bladder meridian on the posterior aspect of the lower limb and their surrounding structures are discussed to get the effective methods for acupuncture.
[Methods]Detailed dissections on the surrounding anatomical structures of the acupuncture points were performed on three cadavers of the Unit of Clinical Anatomy, Graduate School, Tokyo Medical and Dental University.
[Results] 1. BL36 (Chengfu (Chinese), Shofu (Japanese)) and BL37 (Yinmen, Inmon) were situated medial to the posterior femoral cutaneous nerve and the sciatic nerve.
2. BL38 (Fuxi, Fugeki) and BL39 (Weiyang, Iyo) were situated on or near the common peroneal nerve along the media border of the biceps femoris tendon.
3. BL40 (Weizhong, Ichu), BL55 (Heyang, Goyo), BL56 (Chengjin, Shokin), BL57 (Chengshan, Shozan), BL58 (Feiyang, Hiyo), BL59 (Fuyang, Fuyo), BL60 (Kunlun, Konron), BL61 (Pucan, Bokushin) and BL62 (Shenmai, Shinmyaku) were situated along the medial sural cutaneous nerve, sural nerve and small saphenous vein.
4. BL40, BL55, BL56, BL57 were situated along the tibial nerve, the popliteal and posterior tibial arteries deep to the soleus.
[Conclusion] 1. The posterior femoral cutaneous nerve and the sciatic nerve tend to run laterally to BL36 and BL37, so it is necessary to apply the acupunctural treatment lateral to BL36 and BL37 to stimulate these two nerves.
2. The sural nerve and small saphenous vein gradually tend to approach the acupuncture points toward the distal part of the posterior aspect of the leg.
3. BL40, BL55, BL56 and BL57 are shown as the acupuncture stimulation points to the tibial nerve passing the deep part of the posterior aspect of the leg.

1)We visited the Duke–NUS Graduate Medical School Singapore to learn the administration and management of, and the theory behind, team–based learning (TBL), a candidate educational method to replace the problem–based learning tutorial.
2)TBL motivates students to prepare for and engage in discussion. The grading of performance in TBL, certain characteristics of assignments, and the use of peer evaluation all promote individual and group accountability for learning.
3)To obtain the maximum overall benefit from TBL and to exploit group dynamics for effective learning, well–designed assignments are the key.

Objective: We carried out this study to clarify whether operative methods of laparoscopic prostatectomy (LRP) could become a standard therapy. The purpose was to evaluate the technical feasibility, oncologic effectiveness and perioperative and postoperative morbidity of LRP performed by a general urologist. Patients and Methods: Between June 2004 and May 2006, 30 patients with clinically localized prostate cancer consecutively underwent LRP by a single surgeon. Oncologic data were assessed by histopathological examination and by postoperative prostate-specific antigen (PSA) levels. Results: Complete laparoscopic removal of the prostate and seminal vesicles was achieved in all 30 patients. The average operation time was 250.9 min (range, 168 to 394 min). The total positive surgical margin rate was 20.7% (6 of 29 cases), with a total PSA recurrence rate was 23.3% (7 of 30 cases), but the frequencies tended to be decreased in the later phase cases. Perioperative complications were encountered in 5 patients; four of these patients were in the initial 10 cases. Two of the 30 cases (6.7%) required a blood transfusion (first case and 11th case). There were three surgical complications, one ureter injury, one rectal injury and one sigmoid serosal injury. The catheter duration intervals were reduced in the later cases. Conclusions: From our experience with one surgeon, with whom perioperative complications were concentrated in the initial 10 cases, we conclude that LRP should be performed by experienced surgeons after intensive training.

[Objective]More accurate anatomical data is discussed to reveal the surrounding structures of the new and former BL54 (Zhibian, Chippen) according to the positional modification of acupuncture points by WHO (2006), and also to demonstrate the acupuncture stimulation points to the sciatic nerve as effective methods for acupuncture treatment of the pain in the lower back.
[Methods]Detailed dissections were performed on the surrounding structures of the acupuncture points of the bladder meridian at the gluteal region and the posterior aspect of the thigh in three cadavers at the Unit of Clinical Anatomy, Graduate School, Tokyo Medical and Dental University.
[Results] 1. The new BL54 (WHO, 2006) was situated at or near the infrapiriform foramen, with the posterior femoral cutaneous nerve, inferior gulteal nerve and vessels and sciatic nerve passing through.
2. The former BL54 was situated at or near the suprapiriform foramen with the inferior gulteal nerve and vessels passing through.
3. The acupuncture stimulation points to the sciatic nerve at the gluteal region and the posterior aspect of the thigh were as follows;(1) the initial portion of the sciatic nerve, (2) the infrapiriform foramen (new BL54, WHO), (3) the lateral one third point of the line connecting the sacrococcygeal junction and the greater trochanter, (4) the midpont of the line connecting the ischial tuberosity and the greater trochanter, (5) the point about 1 cm lateral to BL36 (Chengfu, Shofu), (6) the medial half portion of the biceps femoris muscle lateral to BL37 (Yinmen, Inmon).
[Conclusion] 1. The new and former BL54 are situated near the main nerves and vessels of the gluteal region and the posterior aspect of the thigh, so are considered as effective points for the acupunctural treatment.
2. The six positions are showed as the acupuncture stimulation points to the sciatic nerve in the gluteal region and the posterior aspect of the thigh.